CORRELATES OF DISABLEMENT IN POLYARTICULAR JUVENILE CHRONIC ARTHRITIS--A CROSS-SECTIONAL STUDY

To assess the impact of disease on the functional outcome ofpatients with polyarticular juvenile chronic arthritis (JCA),the relationship between impairments and functional limitationswas studied. Therefore, variables from the impairment domainwere correlated with variables of the functional limitationdomain and outcome variables were analysed for differences asa result of inflammatory disease, rheumatoid factor (RF), diseaseduration and age at onset. Twenty-three patients with polyarticularJCA were subjected to auxologic evaluation, a laboratory check,radiographic evaluation, joint count on tenderness and swelling,joint mobility/deformity examination, functional assessmentof skills, health assessment and psychosocial evaluation. Inflammatorydisease parameters, like CRP, ESR, thrombocytosis and leucocytosis,were increased in 6/23 patients. The parameters of the impairmentdomain, like joint tenderness and swelling, showed mild outcome,while parameters of the functional limitation domain showedmore severe outcome. Generally, perceived competence was foundto be normal. A clinically relevant number of patients (10/13)showed low scores on the activity factor of the Child BehaviourCheck List (CBCL). A significant relationship was found betweeninflammatory disease variables and functional limitation outcome.RF seropositivity was not a good outcome predictor. Diseaseduration and age of onset showed no significant difference inthe outcome of the domains. Significant correlation was foundbetween the parental report of the Childhood Health AssessmentQuestionnaire (CHAQ) and all impairment parameters. Joint swellingshowed a significant relationship with CHAQ and Juvenile ArthritisFunctional Assessment Report (JAFAR). Disability outcome didnot correlate with functional limitation. In general, childrenwith polyarticular JCA function rather well when using a multidomainevaluation approach. Compensatory and adaptational mechanismsmight contribute to the poor correlation between impairmentand functional limitation parameters. Laboratory evaluationof inflammatory disease, a joint count of swollen joints andparent's report of the child's health status related best inour study. KEY WORDS: Polyarticular uvenile chronic arthritis, Multidimensional outcome measurements, Functional status, Health assessment     

MORTALITY OF JAMAICAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

A retrospective study of all patients with systemic lupus erythematosus(SLE) who died at the University Hospital of the West Indiesover a 14-year period is presented. The major cause of deathwas infection followed by renal failure. Gram-negative organismswere the major microbiological agents causing infections. Side-effectsof therapy were common, in particular bone marrow depressionand haemorrhage related to anticoagulants. It appears that controllingsevere lupus activity without increasing the risk of life-threateningcomplications remains an important goal in the treatment ofSLE. KEY WORDS: Systemic lupus erythematosus, Mortality, Infection, Anticoagulants, Jamaica     

Treatment of prosthetic tricuspid valve thrombosis with recombinant tissue-type plasminogen activator

Recombinant tissue-type plasminogen activator (rt-PA) was admministeredintravenously to a 64-years old female with thrombotic malfunctionof a Björk–Shiley prosthetic tricuspid valve. 150mg of single-chain rt-PA was infused over 8 hours followed byan additional dose of 50 mg over the next 8 hours. At the endof the first infusion, restoration of normal valve functionwas demonstrated by fluoroscopic and echo-Doppler examinations.Mild systemic activation of the fibrinolytic system occurred,with a decrease of fibrinogen and ₂-antiplasmin to 53% and 33%,respectively, of the preinfusion value at the nadir.